Pulse Contour Analysis for Prediction of Fluid Responsiveness in Preeclamptic Patients: A Case Series
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 3
Abstract
Preeclampsia (PE) is a pregnancy-specific syndrome characterized by maternal cardiac output (CO) alterations and relative hypovolemia. In patients with PE is mandatory to predict Fluid Responsiveness (FR), above all if caesarean section (CS) under spinal anesthesia is required. The fluid challenge (FC) is a diagnostic approach to hemodynamic management which aims at identifying the patients who respond to fluid administration with an increase in CO. We present a case series to evaluate the effectiveness of a FC in increasing Cardiac Index (CI) in a group of preeclamptic patients using a continuous pulse-contour analysis. We studied the percentage of patients with PE scheduled for caesarean delivery who had a 15% increase of CI after a FC, in comparison with a control group of healthy pregnant patients. At baseline the patients in PE group showed higher Mean Arterial Pressure (MAP) and lower Stroke Volume Index (SVI). Fifteen patients were non responders (69% of the patients in PE group and 46% of the patients in control). We suggest that the hemodynamic measurement of CI is useful to guide fluid therapy in pregnant woman with PE, and caution should be taken during fluid administration in all healthy pregnant woman at term.Preeclampsia (PE) is a pregnancy-specific multi-organ syndrome secondary to generalized vascular endothelial activation and vasospasm [1,2]. Maternal hemodynamic state is characterized by high vascular resistances, cardiac output (CO) alterations and relative hypovolemia [2]. Above all the women who develop “early onset” PE (time of the diagnosis at or before 34 weeks of gestational age) show evidence of left ventricular mild diastolic dysfunction and segmental impaired myocardial relaxation [2]. Several authors stated that assessment of maternal hemodynamic in women with PE is fundamental for appropriate fluid management [3,4]. Insufficient intravascular volume as fluid excess can lead to life-threatening scenarios, such as decreased oxygen delivery to tissues with multiorgan dysfunction, or fluid extravasation and pulmonary oedema [4]. Poor fluid management in PE has been reported as leading cause of admission to an intensive care unit and maternal deaths [3]. In these patients is mandatory to predict fluid responsiveness (FR), especially if caesarean section under spinal anesthesia is required, as adequate fluid therapy aimed at optimization of CO could be effective to prevent spinal induced hypotension and uteroplacental hypoperfusion [5]. Different studies suggested some strategies to evaluate fluid responsiveness [3,6]. but the debate about the best way to assess it is still open. The fluid challenge (FC) is a reliable diagnostic approach to hemodynamic management which aims at identifying the patients who respond to fluid administration with an increase in blood pressure or CO [7,8]. To our knowledge, FC with CO analysis was never tested in PE. We, therefore decided to evaluate if a FC might have the ability to predict FR in a group of preeclamptic patients using a continuous pulse-contour analysis.
Authors and Affiliations
Luciano Frassanito, Massimo Antonelli, Antonio Messina, Davide Colombosa, Gaetano Draisci
Keywords
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- EP ID EP588438
- DOI 10.26717/BJSTR.2018.05.001210
- Views 129
- Downloads 0
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